The Ellerslie School Student Information Form

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Student

Please enter information for the student

Surname *

Firstname *

Date of Birth *

YYYY

Form *

Street Address *

Parish *

Parent/Guardian 1

Please enter information for the parent/ guardian with whom the child presently resides.

Surname 1 *

First Name 1 *

Relationship to student *

Mother

Father

Other:

Street Address 1 *

Parish 1 *

Email address 1

Home number 1

Work number 1

Cell number 1

Parent/Guardian 2

Surname 2

First Name 2

Relationship to student

Mother

Father

Other:

Clear selection

Street Address 2

Parish 2

Email address 2

Home number 2

Work number 2

Cell number 2

Submit

Clear form

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